DE NOVO POSTOPERATIVE URINARY INCONTINENCE AFTER PELVIC ORGAN PROLAPSE SURGERY
UGIANSKIENE, N. KJÆRGAARD, A. LINDQUIST, T. LARSEN, K. GLAVIND;
Aalborg Univ. Hosp., Aalborg, Denmark.
Introduction: Pelvic organ prolapse (POP) and urinary incontinence (UI) are two common diseases in women and share risk factors such as obesity, age and mainly pelvic floor damage as a consequence of birth. Some women who are preoperatively continent experience de novo incontinence or “masked incontinence” after an operation for prolapse. The theory behind de novo UI is that the prolapse creates a mechanical kinking on the urethra or a cushion effect and that the support under the urethra disappears once the prolapse is treated, but the reason still remains unclear. The exact incidence of de novo incontinence is unknown and the reported incidences vary between 2 % and 43 %.
Objective: The purpose of the study was to investigate the incidence and types of de novo UI following prolapse surgery in preoperatively continent women and to investigate demographic data (table 1) and differences in operations in the three compartments.
Methods: Retrospective study of 678 women with prolapse surgery during a 3-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) (maximum of 17 for worst prolapse symptoms) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) (maximum of 21 for worst incontinence) before undergoing surgery and 3 months postoperatively. Continent patients who scored 0 on ICIQ-UI SF before surgery were included in the study (N=299). The patients developing new onset UI on ICIQ-UI SF postoperatively were interviewed by telephone for a long-time follow up.
Results: A total of 33 patients (11%) developed subjective de novo UI at 3 months follow-up. The majority of patients reported stress UI (48.5%) and 36.4 % urge UI, 9.1% mixed UI and 6.1% undefined UI. At long-term follow-up (median 30 months) 12 patients became continent without incontinence surgery or medical treatment leaving only 21 patients (7%) incontinent. The risk of developing de novo UI increased with parity (p=0.03). We found no difference between operations in different compartments. Pre- and postoperative data on the ICIQ -VS score showed statistically significant improvement in all 33 patients, with preoperative mean score of 12 declining to 0.78 at 3 months follow-up. At the long-term follow-up, the mean prolapse score was slightly higher with a mean score of 2.78.
Conclusions: The risk of developing de novo UI after prolapse surgery with native tissue repair is low and decreasing over time. Parity is significantly associated with risk of developing de novo UI. There is no significant difference in the incidence of de novo incontinence between the different groups of surgery.